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Sabesan V, Ogunfuwa F, Grunhut J, Sommerville S, Fomunung C, Elkhechen J, Fernandez C, Lavin A, Jackson GR. Telemedicine in orthopaedics during the COVID-19 pandemic: a comparative landscape. Int Orthop 2024; 48:1149-1155. [PMID: 38367059 DOI: 10.1007/s00264-024-06098-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/18/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE The purpose of this study was to provide a comprehensive analysis on observed trends regarding the impact of the COVID-19 pandemic on telemedicine application in orthopaedics compared to other procedural, non-emergent specialties. METHODS This was a retrospective review of all telemedicine and in-person visits at a large single institution from January to December 2020. The number of patient visits, visit type, location, and provider specifics were collected. Comparisons were made between subspecialties (orthopaedic surgery, oncology, family medicine, rheumatology) for analyses. RESULTS All specialties included were not conducting virtual visits at the beginning of 2020. By April 2020, orthopaedic virtual visits spiked to an all-time high of 33.5% of all patient visits as compared to oncology at 25.5%, rheumatology at 92.9%, and family medicine at 94%. By the end of the study period, orthopaedic virtual visits decreased back down to 6.5% of patient visits compared to oncology at 7.0%, and family medicine (17.4%) and rheumatology (26.2%). Orthopaedic providers practicing greater than 20 years had the highest average virtual visit rates. CONCLUSION Although the COVID-19 pandemic has posed unique challenges for healthcare providers, there was a great advancement in the rollout and application of telemedicine. To mitigate the spread of infection from coronavirus and given the recent adjustments to reimbursement policies and HIPAA regulations, orthopaedics saw a dramatic expansion of telemedicine since April 2020. The pandemic may have served as a catalyst to adopt telehealth into clinical practice. However, telehealth saw a downtrend trend by December 2020, particularly in procedure-based fields like orthopaedics and oncology.
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Affiliation(s)
- Vani Sabesan
- Palm Beach Shoulder Service HCA FL - Atlantis Orthopaedics, 900 Village Square Crossing Suite 170, Palm Beach, FL, USA.
- HCA JFK/University of Miami Miller School of Medicine Orthopaedic Surgery Residency Program, Palm Beach, FL, USA.
- Levitetz Dept of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
| | - Feyikemi Ogunfuwa
- Charles E. Schmidt College of Medicine at, Florida Atlantic University, Boca Raton, FL, USA
| | - Joel Grunhut
- Charles E. Schmidt College of Medicine at, Florida Atlantic University, Boca Raton, FL, USA
| | - Shad Sommerville
- Charles E. Schmidt College of Medicine at, Florida Atlantic University, Boca Raton, FL, USA
| | - Clyde Fomunung
- Palm Beach Shoulder Service HCA FL - Atlantis Orthopaedics, 900 Village Square Crossing Suite 170, Palm Beach, FL, USA
- HCA JFK/University of Miami Miller School of Medicine Orthopaedic Surgery Residency Program, Palm Beach, FL, USA
| | - Justin Elkhechen
- Palm Beach Shoulder Service HCA FL - Atlantis Orthopaedics, 900 Village Square Crossing Suite 170, Palm Beach, FL, USA
- HCA JFK/University of Miami Miller School of Medicine Orthopaedic Surgery Residency Program, Palm Beach, FL, USA
| | - Carlos Fernandez
- Palm Beach Shoulder Service HCA FL - Atlantis Orthopaedics, 900 Village Square Crossing Suite 170, Palm Beach, FL, USA
- HCA JFK/University of Miami Miller School of Medicine Orthopaedic Surgery Residency Program, Palm Beach, FL, USA
| | - Alessia Lavin
- Palm Beach Shoulder Service HCA FL - Atlantis Orthopaedics, 900 Village Square Crossing Suite 170, Palm Beach, FL, USA
| | - Garrett R Jackson
- Palm Beach Shoulder Service HCA FL - Atlantis Orthopaedics, 900 Village Square Crossing Suite 170, Palm Beach, FL, USA
- HCA JFK/University of Miami Miller School of Medicine Orthopaedic Surgery Residency Program, Palm Beach, FL, USA
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Macknofsky B, Fomunung CK, Brown S, Baran JV, Lavin AC, Sabesan V. Concussion Rates in Youth Lacrosse Players and Comparison With Youth American Football. Orthop J Sports Med 2024; 12:23259671231223169. [PMID: 38390398 PMCID: PMC10883126 DOI: 10.1177/23259671231223169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/31/2023] [Indexed: 02/24/2024] Open
Abstract
Background There has been little focus on concussions in youth lacrosse players in the United States. Purpose To provide a descriptive analysis of the epidemiology and incidence of concussions in youth lacrosse and compare the results with well-documented analyses of concussions in youth American football. Study Design Descriptive epidemiology study. Methods Data on concussions in pediatric patients playing lacrosse from 2006 to 2019 were collected using the National Electronic Injury Surveillance System (NEISS). Weighted calculations and combined participation data obtained from membership in USA Lacrosse were used to estimate injury incidence. A comparison dataset was created using the NEISS data on youth football-related concussions. The cause of concussion was categorized into player-to-player, player-to-stick, player-to-ball, or player-to-ground contact. Results A total of 37,974 concussion injuries related to lacrosse were identified in players with a mean age of 14.5 ± 3.5 years; 70% of concussions occurred in boys. National participation in lacrosse increased from 2006 to 2011 by a mean of 10.3% annually, followed by a lower annual growth rate of 2.5% from 2012 to 2019. The overall incidence of concussion injuries increased over the study period (r = 0.314), with the incidence rate in boys being greater than that of girls from 2009 to 2013. The most common cause of concussion was player-to-ground contact for boys and player-to-ball or player-to-stick contact for girls. The mean annual concussion incidences in youth lacrosse and youth football were 443 and 355 per 100,000 participants, respectively. Conclusion Over the study period, 16% of lacrosse injuries were diagnosed as concussions, a higher mean annual incidence per 100,000 participants than that of youth football (443 vs 355). The cause of concussion was different based on sex, with higher rates of player-to-ball or player-to-stick contact in female players versus player-to-ground contact in male players.
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Affiliation(s)
- Brandon Macknofsky
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
| | - Clyde K Fomunung
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
| | - Shimron Brown
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
| | - Jessica V Baran
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
| | - Alessia C Lavin
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
| | - Vani Sabesan
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
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Snethen K, Braman JP, Sabesan V, Bandi M, Bischoff J. Quantification of the passive behavior of the glenohumeral joint: A biomechanical study. J Biomech 2024; 163:111912. [PMID: 38183762 DOI: 10.1016/j.jbiomech.2023.111912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/08/2024]
Abstract
Shoulder stabilization and arthroplasty procedures aim to restore the complex motion innate to the glenohumeral joint relying on proper tensioning of the surrounding soft-tissues at the time of surgery. Joint instability remains a leading cause for revisions of these procedures necessitating a deeper understanding of the passive constraint of the intact glenohumeral joint. The current literature lacks comprehensive analysis of the passive glenohumeral joint in all degrees-of-freedom (DOF). The objective of the present study is to better understand this complex joint by quantifying the passive laxity of the glenohumeral joint in multiple DOFs over a range of motion. Sixteen fresh-frozen cadaveric shoulders were tested in the intact state using a robotic simulator capable of six-DOF motion. The limits of range of motion was quantified in separate laxity tests applying a ± 2 Nm internal-external (IE) torque, ±20 N anterior-posterior (AP) force, ±20 N superior-inferior (SI) force and a 44 N distraction force at six levels of glenohumeral abduction. Overall, glenohumeral joint laxity was greatest between 15° and 45° of abduction except for SI translation which increased with abduction. IE rotation and AP translation were dominated by external rotation and anterior translation, respectively. Although early abduction and late abduction produced similar laxities, the increase in laxity in the mid abduction range indicates it is important to assess the shoulder joint throughout the range of motion and not just at these two end points. The presented laxity data establishes a baseline for intact shoulder laxity over a range of motion in multiple DOFs under known loading conditions.
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Affiliation(s)
| | - Jonathan P Braman
- Department of Orthopaedic Surgery, University of Minnesota, Rochester, MN, United States
| | - Vani Sabesan
- HCA Florida - Atlantis Orthopaedics, Lake Worth, FL, United States
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Sabesan V, Dawoud M, Al-Mansoori A, Stephens BJ, Lavin AC, Lozano JM, Fomunung CK. Factors influencing physical therapy utilization after shoulder surgery: a retrospective review. JSES Rev Rep Tech 2023; 3:511-518. [PMID: 37928991 PMCID: PMC10625012 DOI: 10.1016/j.xrrt.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Postoperative physical therapy (PT) is a cornerstone to achieve optimal patient outcomes. Access to postoperative PT can be limited by insurance type, coverage, and cost. With copayments (CP) for PT as high as $75 per visit, PT can be costprohibitive for patients. The purpose of this study was to evaluate factors affecting PT utilization among patients that underwent shoulder surgery. Methods A retrospective analysis was performed of 80 shoulder surgery patients with postoperative PT sessions attended at a single institution from 2017 to 2019. Patients were divided based on insurance type: private insurance (PI), and Medicare with or without supplemental insurance (MI), and CP or no copayment. Demographics, CP, total, and postoperative number of PT sessions utilized was collected and analyzed. Results The cohort had 53 females and an average age of 62. There was no significant difference between PI and MI at baseline other than surgery performed (P = .03), older MI group (69 years vs. 56 years: P < .01), and more females in PI group (76% vs. 55%; P = .05). There was no significant difference in the number of PT sessions between groups. The PI group was more likely to have a CP (P < .01). The CP group more often had PI and significantly more total PT visits (P = .05), while the no copayment group more often had Medicare (P < .01). CP was not independently associated with a change in the number of PT visits or total PT visits. Conclusions The utilization of PT after shoulder surgery was found to not be influenced by insurance type or CP as determined by the number of PT sessions attended. Further investigations are necessary to better understand the relationship between CP and different insurance types and develop effective strategies to increase access to PT for postoperative shoulder patients.
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Affiliation(s)
- Vani Sabesan
- HCA Florida JFK Hospital, Palm Beach Shoulder Service – Atlantis Orthopaedics, Palm Beach, FL, USA
- Cleveland Clinic Florida, Levitetz Department of Orthopedic Surgery, Weston, FL, USA
| | - Mirelle Dawoud
- Cleveland Clinic Florida, Levitetz Department of Orthopedic Surgery, Weston, FL, USA
| | - Ahmed Al-Mansoori
- Cleveland Clinic Florida, Levitetz Department of Orthopedic Surgery, Weston, FL, USA
| | - B. Joshua Stephens
- Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, FL, USA
| | - Alessia C. Lavin
- HCA Florida JFK Hospital, Palm Beach Shoulder Service – Atlantis Orthopaedics, Palm Beach, FL, USA
| | - Juan Manuel Lozano
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Clyde K. Fomunung
- HCA Florida JFK Hospital, Palm Beach Shoulder Service – Atlantis Orthopaedics, Palm Beach, FL, USA
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Sabesan V, Lapica H, Fernandez C, Fomunung C. Evolution of Perioperative Pain Management in Shoulder Arthroplasty. Orthop Clin North Am 2023; 54:435-451. [PMID: 37718083 DOI: 10.1016/j.ocl.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Historically, opioids have been used as a primary conservative treatment for pain related to glenohumeral osteoarthritis (GHOA). However, this practice is concerning as it often leads to overuse, which has contributed to the current epidemic of addiction and overdoses in the United States. Studies have shown that preoperative opioid use is associated with higher complication rates and worse outcomes following surgery, particularly for shoulder arthroplasty. To address these concerns, perioperative pain management for shoulder arthroplasty has evolved over the years to the use of multimodal analgesia.
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Affiliation(s)
- Vani Sabesan
- Department of Orthopedics, JFK/University of Miami, Palm Beach, FL, USA.
| | - Hans Lapica
- Department of Orthopedics, JFK/University of Miami, Palm Beach, FL, USA
| | - Carlos Fernandez
- Department of Orthopedics, JFK/University of Miami, Palm Beach, FL, USA
| | - Clyde Fomunung
- Department of Orthopedics, JFK/University of Miami, Palm Beach, FL, USA
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Yerke Hansen P, Macknofsky B, Busheme CE, Fomunung CK, Lavin AC, Fernandez CA, Sabesan V. Access to Total Knee Arthroplasty for Military Insured Patients. Arthroplast Today 2023; 21:101143. [PMID: 37521086 PMCID: PMC10382688 DOI: 10.1016/j.artd.2023.101143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/13/2023] [Accepted: 03/25/2023] [Indexed: 08/01/2023] Open
Abstract
Background Rigorous training may lead to increased rates of knee osteoarthritis and arthroplasties in military service members. Given the large numbers of arthritis and the increasing need for total joint replacements, access to appropriate care can be difficult for this population based on insurance restrictions. The aim of this study was to evaluate access to total knee arthroplasty for TRICARE patients in contracted civilian medical facilities. Methods Orthopedic surgeons contracted to perform total knee replacements in the state of Florida were identified via TRICARE's website. Investigators used a secret shopper methodology with a standardized script to request an appointment for their family member for a total knee arthroplasty using either TRICARE Select or BlueCross preferred provider organization. The appointment acceptance rates, wait times, call duration, and accuracy of the physician listing were collected. Results A total of 228 offices that perform total knee arthroplasties in Florida were successfully contacted. Overall, 43.1% of the clinics had an inaccurate online listing, and 207 (91%) were able to schedule an appointment with TRICARE, compared to 93% for BlueCross Blue Shield (P = .06). The average wait for TRICARE patients was 24 days and 18 days for BlueCross (P < .01). Call times for TRICARE patients averaged 7.2 minutes, compared to 5.2 minutes for BlueCross (P < .01). Conclusions TRICARE patients encountered longer waiting periods and inaccurate provider listings when accessing orthopedic care. Our results suggest a disparity in healthcare access for patients using TRICARE, which may result in negative health outcomes from receiving delayed care.
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Affiliation(s)
- Payton Yerke Hansen
- Charles E. Schmidt College of Medicine Florida Atlantic University, Boca Raton, FL, USA
| | - Brandon Macknofsky
- Charles E. Schmidt College of Medicine Florida Atlantic University, Boca Raton, FL, USA
| | - Cara E. Busheme
- Charles E. Schmidt College of Medicine Florida Atlantic University, Boca Raton, FL, USA
| | - Clyde K. Fomunung
- Department of Orthopaedics, JFK/University of Miami, Palm Beach, FL, USA
- Palm Beach Shoulder Service at Atlantis Orthopaedics, Lake Worth, FL, USA
| | - Alessia C. Lavin
- Department of Orthopaedics, JFK/University of Miami, Palm Beach, FL, USA
- Palm Beach Shoulder Service at Atlantis Orthopaedics, Lake Worth, FL, USA
| | - Carlos A. Fernandez
- Department of Orthopaedics, JFK/University of Miami, Palm Beach, FL, USA
- Palm Beach Shoulder Service at Atlantis Orthopaedics, Lake Worth, FL, USA
| | - Vani Sabesan
- Department of Orthopaedics, JFK/University of Miami, Palm Beach, FL, USA
- Palm Beach Shoulder Service at Atlantis Orthopaedics, Lake Worth, FL, USA
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Sabesan V, Chatha K, Guo E, Whaley J, Amador M, Lavin A. Performance Metrics and Economics of SLAP Repairs in Major League Baseball Pitchers. JSES Int 2022; 6:569-572. [PMID: 35813154 PMCID: PMC9264029 DOI: 10.1016/j.jseint.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Superior labrum anterior-posterior tears (SLAP) can be a career-altering injury for Major League Baseball (MLB) pitchers. Surgery and postoperative rehabilitation keep pitchers on the injured list (IL) for extended time, which results in a significant cost to a team. To date, no analyses have focused on the financial cost of SLAP repairs in MLB pitchers. Methods A retrospective review of MLB pitchers with SLAP repair from 2004 to 2019 was conducted utilizing IL and financial contract data from the MLB website. Cost of injury was calculated from salary of the player. Performance metrics including earned run average, walks + hits per innings pitched, and innings pitched (IP) were averaged for one and all seasons played before and after injury. Return to play and return to prior performance rates were calculated and reported. Results Of the 55 players identified, 22 players (40%) returned to play and 18 of these 22 players (82%) returned to prior performance. Annual cost increased over the study period (R2 = 0.288) averaging $3.5 million, and a stable average of 172 days was spent on the IL (R2 = 0.001). Performance was negligible except IP (106.95 vs. 50.85; P < .01) for 1 season before and after injury. For all seasons, earned run average and walks + hits per innings pitched significantly increased (4.13 vs. 5.19; P = .030, and 1.36 vs. 1.53; P = .033, respectively), while IP downtrended without significance (P = .058). Conclusion SLAP repairs in MLB pitchers have significant financial impact and time spent on the IL, which surprisingly has not changed over time. It is encouraging to know return-to-play pitchers return without profound decline in performance level following SLAP repair.
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Sabesan V, Dawoud M, Chatha K, Koen S, Khoury L. What do patients think about opioids? a survey of patient perceptions regarding pain control after shoulder surgery. JSES Int 2021; 5:920-924. [PMID: 34505106 PMCID: PMC8411061 DOI: 10.1016/j.jseint.2020.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background There is an increasing need to understand what barriers are present to reduce opioid consumption in orthopedic practice. The purpose of this study was to better understand patient perceptions and understanding of opioid use after shoulder surgery. Methods Eighty-five patients who underwent shoulder surgery anonymously completed a 27-question survey adapted from the Maryland Public Opinion Survey on Opioids with additional demographics. The patients were asked about pain expectations after surgery, use of and access to opioids, opioid perceptions, and information provided regarding safe use, storage, and disposal of opioids. Results When asked about receiving information regarding opioids, only 36% of the patients reported having a conversation with their physician. When asked about appropriate use, 10% agree it is permissible to take more than the recommended dosage of prescription narcotics if they are feeling more pain than usual and 8.5% of the patients reported taking an opioid to get high multiple times in the past year. Furthermore, a majority agreed that opioids may lead to other substance abuse with 76% reporting the risk of harm to be great, and only 55% believing that opioid abuse may lead to overdose or death. Conclusions Surgeons need to be aware that most patients expect to have significant pain after shoulder surgery and expect to be given necessary and continued amounts of opioids. This highlights the need for better counseling and innovative nonopioid pain management protocols. At the institutional level, more effort needs to be made on providing adequate education and disposal mechanisms to help reduce diversion and misuse.
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Affiliation(s)
- Vani Sabesan
- Levitetz Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Mirelle Dawoud
- Charles E Schmidt School of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Kiran Chatha
- Levitetz Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Sandra Koen
- Levitetz Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Laila Khoury
- Charles E Schmidt School of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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Sabesan V, Chatha K, Lima DJ, Yawman JP, Khoury L, Routman H. Equal care for all? Do surgical outcomes in shoulder arthroplasty depend on insurance type? JSES Int 2021; 5:900-904. [PMID: 34505103 PMCID: PMC8411063 DOI: 10.1016/j.jseint.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although it has been shown that Medicare populations have a higher overall rate of complications than those with private insurances for large cohort total joint studies, there is limited information comparing patient-reported outcomes (PROs) among private insurance patients. The purpose of this study was to determine the impact of non-Medicaid insurance type on outcomes after shoulder arthroplasty. METHODS This retrospective case-controlled study included 203 patients who underwent shoulder arthroplasty from 2012 to 2017 by a single surgeon. Preoperative and postoperative PROs were collected and included the Simple Shoulder Test, the American Shoulder and Elbow Surgeons Shoulder Assessment Form, and the Constant Shoulder Score. Patients were categorized into groups based on insurer-preferred provider organization, health maintenance organization, Medicare, and Veterans Affairs Care program-and outcomes were compared between groups. RESULTS The 4 insurance provider groups were matched for body mass index, surgery type, and comorbidities (P = .526). Preoperatively, no significant differences in PROs between groups were present except for the Constant Shoulder Score (P = .029). All payer groups significantly improved from preoperative to postoperative PROs (P ≤ .001). At the final follow-up, no significant difference in PROs between groups were seen (American Shoulder and Elbow Surgeons Shoulder mean 75.3 ± 20.9 [P = .757], Simple Shoulder Test of 9.1 ± 2.9 [P = .312], and Constant Shoulder Score of 65.0 ± 15.2 [P = .526]). CONCLUSIONS Our results suggest variations in insurance type did not significantly impact outcomes for our cohort of patients undergoing shoulder arthroplasty. Although variations in patient cohorts exist, patients regardless of insurance type and coverage variations can expect significant improvements in their function and pain after shoulder arthroplasty.
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Affiliation(s)
- Vani Sabesan
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Kiran Chatha
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Diego J. Lima
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | | | - Laila Khoury
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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Chatha K, Pruis T, Peaguda CF, Guo E, Koen S, Malone D, Sabesan V. Concussions in Soccer: An Epidemiological Analysis in the Pediatric Population. Orthop J Sports Med 2020; 8:2325967120951077. [PMID: 33173798 PMCID: PMC7588758 DOI: 10.1177/2325967120951077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/18/2019] [Indexed: 11/15/2022] Open
Abstract
Background As the popularity of youth soccer has increased in the United States, more attention has been focused on the effect of concussion injuries, with recent debate on whether heading should be disallowed. There is little evidence examining the epidemiology of these injuries. Purpose/Hypothesis The purpose of this study was to examine the prevalence and incidence of youth soccer-related concussions. We hypothesized that concussion rates will correlate with increased participation in youth soccer. Study Design Descriptive epidemiology study. Methods The National Electronic Injury Surveillance System was used to collect data on concussion injuries that occurred during soccer in pediatric patients from 2008 through 2016. Soccer-related concussion injuries were identified using specific codes and were analyzed for variation in disposition. The types of contact were categorized into player-to-player, head-to-ball, player-to-post, and player-to-ground contacts. Contact types related to hospitalization were subanalyzed. Results A weighted total of 3285 concussion injuries were identified during the study period, with an average of 386 concussions each year. The average age was 13.5 years, and there were no differences seen in incidence between the sexes. The overall incidence of concussion injuries increased (r = 0.789), while hospitalizations decreased (r = -0.574). The most common cause of concussion was found to be player-to-player contact, followed by head-to-ground contact and then head-to-ball contact. Subanalysis showed that 13% of hospitalizations were due to head-to-ball contact, compared with 39% and 44% due to player-to-player contact and head-to-ground contact, respectively. The relative risk of hospitalization from a concussion due to head-to-ball contact was 7.06 compared with 22.60 due to head-to-ground contact. Conclusion The incidence of concussion in youth soccer has been increasing over the past decade as predicted, given the growing participation rates in both male and female soccer players. The most common cause of concussion was player-to-player contact, and the majority of concussions resulting in hospitalization occurred because of head-to-ground contact.
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Affiliation(s)
- Kiran Chatha
- Levitetz Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Taylor Pruis
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | - Eric Guo
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sandra Koen
- Levitetz Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Danielle Malone
- Levitetz Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Vani Sabesan
- Levitetz Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, Florida, USA
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Petersen-Fitts G, Gambone A, Sherwood A, Whaley J, Katz DL, Lima DJL, Sabesan V. Comparison of Microbial Count on Various Surfaces in Operating Rooms at Different Times of the Day. J Surg Orthop Adv 2018; 27:281-285. [PMID: 30777827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to determine the degree of microbial contamination of surfaces in the operating room (OR) and to understand the relationship between time and location of contamination. Five OR surfaces were sampled at two time points on three consecutive Mondays and Thursdays. Each sample was cultured on a blood agar plate and introduced to a liquid nutrient broth. The most sterile surface was the OR lights with only one positive growth sample at each time. At both times, the most commonly contaminated surface was the staff keyboard. Coagulase-negative staphylococcus was the most common isolated species. Contamination rate of OR surfaces was not affected by time of day or day of the week. Simple cleaning and daily decontamination of staff keyboards can significantly reduce bacterial burdens and should be of primary importance to optimize OR sterility. (Journal of Surgical Orthopaedic Advances 27(4):281-285, 2018).
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Affiliation(s)
| | - Andrew Gambone
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Taylor, Michigan
| | - Alexandria Sherwood
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Taylor, Michigan
| | - James Whaley
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Taylor, Michigan
| | - Danielle L Katz
- Department of Orthopaedics, Cleveland Clinic Florida, Weston, Florida
| | - Diego J L Lima
- Department of Orthopaedics, Cleveland Clinic Florida, Weston, Florida
| | - Vani Sabesan
- Department of Orthopaedics, Cleveland Clinic Florida, Weston, Florida; e-mail:
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Sabesan V, Whaley J, Petersen-Fitts G, Sherwood A, Sweet M, Lima DJL, Malone D. The effect of Medicaid payer status on patient outcomes following repair of massive rotator cuff tears. Musculoskelet Surg 2017; 102:267-272. [PMID: 29185162 DOI: 10.1007/s12306-017-0528-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/08/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The influence of socioeconomic status and insurance type has not been studied extensively for RCR, particularly not in the high risk massive RCT population. The purpose of this study is to identify relationships between Medicaid payer status and patient outcomes following massive RCR. METHODS A retrospective review of shoulder surgery database identified 29 patients undergoing massive rotator cuff repair. Patients were stratified based on insurance type into two cohorts, Medicaid (14 patients) and non-Medicaid (15 patients). Missed routine follow-up appointments and comorbidities were recorded and compared between groups. Group comparisons were made for pre- and postoperative patient-reported and functional outcomes. Outcome scores included American Shoulder and Elbow Shoulder Score (ASES), the Penn Shoulder Score, and the Subjective Shoulder Value (SSV). A p value of < 0.05 was considered significant for all statistical analyses. RESULTS Medicaid patients were on average 7.1 years younger than non-Medicaid patients (49.8 vs. 56.9 years, respectively), and remaining demographics were comparable between groups. Preoperative patient-reported outcomes were only significantly different for ASES and ASES pain (p = 0.010, 0.037). There was excellent average improvement for Medicaid patients but no significant differences compared to non-Medicaid patients for ASES (p = 0.630), PENN scores (p = 0.395), and SSV (p = 0.198). Medicaid patients also had a higher number of missed and canceled appointments (28%) compared to non-Medicaid patients (18%). CONCLUSION Medicaid coverage will expand to millions of uninsured Americans under current healthcare reform. Medicaid patients with massive RCT appear to significantly improve with surgical treatment.
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Affiliation(s)
- V Sabesan
- Orthopaedics Department, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
| | - J Whaley
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Taylor, MI, USA
| | - G Petersen-Fitts
- Department of Orthopaedic Surgery, Beaumont Health, Taylor, MI, USA
| | - A Sherwood
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Taylor, MI, USA
| | - M Sweet
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Taylor, MI, USA
| | - D J L Lima
- Orthopaedics Department, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - D Malone
- Orthopaedics Department, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
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Sabesan V, Steffes Z, Lombardo DJ, Petersen-Fitts GR, Jildeh TR. Epidemiology and location of rugby injuries treated in US emergency departments from 2004 to 2013. Open Access J Sports Med 2016; 7:135-142. [PMID: 27822128 PMCID: PMC5087755 DOI: 10.2147/oajsm.s114019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Rugby participation in the US is increasing, and with its inclusion in the 2016 Summer Olympics, the increased participation rates are expected to continue. Naturally, as participation increases, so too do rugby-related injuries. The difference in injury patterns with regard to age and gender illustrates differences in how the game is being played. Understanding what accounts for these emerging injury patterns will help guide future injury prevention efforts. This study provides an update on injury rates for the growing population of rugby players in the US, especially young players. Our results focus on the variation of injury types and the injury rates of various levels of rugby players, including youth, collegiate, and recreational. Using injury data from the National Electronic Injury Surveillance System, we analyzed data in rugby patients for age, gender, body region, type of injury, and severity. We employed statistical weights to calculate national injury estimates. During the 10 years studied, the trend in the number of rugby injuries among all age groups showed a statistically significant increase (R=0.804, P=0.005). The average age of injury was 21.5±6.3 years with facial and head injuries constituting >33% of all injuries, representing a proportional increase of >10%. Men were most frequently injured in the face (18.2%) and head (15.9%); women were most frequently injured in the head (23%) and shoulder (12.3%). There were 9,059 concussions, constituting 7% of all injuries.
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Sabesan V, Callanan M, Sharma V, Wiater JM. Assessment of scapular morphology and surgical technique as predictors of notching in reverse shoulder arthroplasty. Am J Orthop (Belle Mead NJ) 2015; 44:E148-E152. [PMID: 25950544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There has been increased focus on understanding risk factors for scapular notching in reverse shoulder arthroplasty (RSA). We conducted a study to evaluate the scapular notching index and other factors associated with the occurrence of scapular notching. Ninety-one patients treated with primary RSA were followed for a minimum of 24 months. Patients' radiographic assessments were grouped by Nerot grade of scapular notching (group 1, grades 0 and 1; group 2, grades 2, 3, 4). Group mean differences were compared for preoperative scapular neck angle (SNA), prosthesis-scapular neck angle (PSNA), peg glenoid rim distance (PGRD), notching index, and clinical outcomes. There was no significant difference in mean (SD) notching index between group 1, 31.8 (4.4), and group 2, 33.1 (7.3), and there were no significant differences in SNA (102.8° vs 105.4°; P=.3), PSNA (125.8° vs 125.4°; P=.82), PGRD (15.4 vs 16.8 mm; P=.47), or clinical outcomes between the groups. Our results suggest that Grammont-style prostheses have a higher rate of notching regardless of optimal PGRD and variations in PSNA. Perhaps with certain scapular morphology, prosthetic design may be a more significant contributor to notching.
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Affiliation(s)
- Vani Sabesan
- Department of Orthopedic Surgery, Wayne State University School of Medicine, Dearborn, MI.
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Sabesan V, Sharma V, Callanan M, Ho J, Iannotti J. Step-Cut Bone-Graft Technique for Osteoarthritis with Severe Glenoid Bone Loss. JBJS Essent Surg Tech 2014; 4:e14. [PMID: 30775121 DOI: 10.2106/jbjs.st.m.00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction We describe a bone-graft technique, for shoulder arthroplasty in patients with severe glenoid bone loss, that utilizes a "step cut," a trapezoidal bone wedge from the resected humeral head, and graft fixation with screws placed from posterior to anterior through the graft. Step 1 Preoperative Planning Carry out preoperative planning for the step-cut procedure. Step 2 Surgical Approach and Preparation of the Glenoid Expose the glenoid for bone graft insertion, taking care to avoid excessive reaming. Step 3 Prepare the Glenoid Bone Graft Cut the appropriately sized glenoid bone graft from the resected humeral head. Step 4 Insert and Fix the Glenoid Bone Graft Position the bone graft in the glenoid defect and stabilize it with screws. Step 5 Prepare the Glenoid Surface Create an even concave surface between the anterior aspect of the glenoid and the posterior aspect of the graft. Step 6 Place the Glenoid Implant Position the glenoid component following step-cut graft implantation. Postoperative Rehabilitation Postoperative rehabilitation is mostly the same as that for standard total shoulder replacement without bone-grafting. Results The range of motion improved significantly in our study of twelve patients (p < 0.001).IndicationsContraindicationsPitfalls & Challenges.
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Affiliation(s)
- Vani Sabesan
- Western Michigan University School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008. E-mail address for V. Sabesan:
| | - Vinay Sharma
- Western Michigan University School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008. E-mail address for V. Sabesan:
| | - Mark Callanan
- Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, White 535, Boston, MA 02114
| | - Jason Ho
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - Joseph Iannotti
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
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Sabesan V, Callanan M, Sharma V, Iannotti JP. Correction of acquired glenoid bone loss in osteoarthritis with a standard versus an augmented glenoid component. J Shoulder Elbow Surg 2014; 23:964-73. [PMID: 24406121 DOI: 10.1016/j.jse.2013.09.019] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 09/24/2013] [Accepted: 09/26/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The magnitude and anatomic consequences of pathologic acquired glenoid retroversion and posterior bone loss that can be surgically corrected with a standard versus an augmented glenoid component have not been studied extensively in a surgical patient population. MATERIALS AND METHODS Twenty-nine patients with glenohumeral osteoarthritis, acquired posterior bone loss, and increased retroversion were studied by use of a three-dimensional computer surgical simulation. For each case, amount of medialization was measured as the linear distance from the lateral aspect of the glenoid vault model to the center of the articular implant surface. Simulation of implant placement at 0° or 6° was performed with use of a standard glenoid having a uniform thickness and an asymmetric thickness augmented component. RESULTS An increased amount of medialization was seen with the standard glenoid, 8.3 ± 4.1 mm, compared with 3.8 ± 3.3 mm with use of the augmented glenoid implant (P < .001). When glenoid retroversion was corrected to 0°, pathologic version was shown to have strong and significant relationship to the amount of medialization for both the standard (R(2) = 0.825) and augmented (R(2) = -0.68) glenoid implant. There was an increased ability to correct greater amounts of pathologic version with less medialization by use of an augmented step glenoid compared with a standard anchor peg glenoid. DISCUSSION Correction of moderate to severe glenoid retroversion by asymmetric reaming cannot always be done with use of a standard component, and if it is done, it will result in greater medialization of the joint line. Use of an augmented component can allow complete correction of retroversion and minimize the effect of medialization.
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Affiliation(s)
- Vani Sabesan
- Orthopaedic Surgery Western Michigan University School of Medicine, Kalamazoo, MI, USA.
| | - Mark Callanan
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Vinay Sharma
- Western Michigan University School of Medicine, Kalamazoo, MI, USA
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Sabesan V, Callanan M, Sharma V. Guidelines for the selection of optimal glenoid augment size for moderate to severe glenohumeral osteoarthritis. J Shoulder Elbow Surg 2014; 23:974-81. [PMID: 24388714 DOI: 10.1016/j.jse.2013.09.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/24/2013] [Accepted: 09/26/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty is technically demanding in regard to implantation of the glenoid component, especially in the setting of increased glenoid deformity and posterior glenoid wear. Augmented glenoid implants are an important and innovative option; however, there is little evidence accessible to surgeons to guide in the selection of the appropriate size augmented glenoid. METHODS Solid computer models of commercially available augmented glenoid components (+3, +5, +7) contained within the software allowed placement of the best fit glenoid component within the three-dimensional reconstruct of each patient's scapula. Peg perforation, amount of bone reamed, and amount of medialization were recorded for each augment size. RESULTS There was strong correlation between the medialization of the joint line and the glenoid retroversion for each augmented component at neutral correction and correction to 6° of retroversion. At neutral, the range of retroversion that restored the anatomic joint line was -3° to -17° with use of the +3 augmented glenoid, -5° to -24° with the +5 augmented glenoid, and -9° to -31° with the +7 augmented glenoid. At 6° of retroversion, the range of retroversion that restored the anatomic joint line was -4° to -21° with use of the +3 augmented glenoid, -7° to -27° with the +5 augmented glenoid, and -9° to -34° with the +7 augmented glenoid. CONCLUSIONS There was a strong correlation between glenoid retroversion and medialization for all augment sizes, supporting the recommendation for glenoid retroversion as the primary guide in selecting the amount of augmentation.
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Affiliation(s)
- Vani Sabesan
- Orthopaedic Surgery, Western Michigan University School of Medicine, Kalamazoo, MI, USA.
| | - Mark Callanan
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Vinay Sharma
- Orthopaedic Surgery, Western Michigan University School of Medicine, Kalamazoo, MI, USA
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Sabesan V, Callanan M, Ho J, Iannotti JP. Clinical and radiographic outcomes of total shoulder arthroplasty with bone graft for osteoarthritis with severe glenoid bone loss. J Bone Joint Surg Am 2013; 95:1290-6. [PMID: 23864177 DOI: 10.2106/jbjs.l.00097] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenohumeral osteoarthritis may be associated with severe posterior glenoid bone loss and glenoid retroversion. Treatment with total shoulder arthroplasty and autologous bone graft obtained from the humeral head has been infrequently reported in the peer-reviewed literature. METHODS The clinical and radiographic results of primary total shoulder replacement with an all-polyethylene glenoid component and autologous humeral head graft augmentation performed by a single surgeon in thirteen consecutive patients were evaluated. RESULTS Twelve of the thirteen patients were followed for a minimum of two years (average, fifty-three months; range, twenty-six to 110 months). The average glenoid retroversion on preoperative computed tomography (CT) scans was 44° (range, 20° to 65°). Based on the Walch classification of pathologic glenoid morphology, nine glenoids were B2 and three were type C. All patients had an intact cuff at the time of surgery. At the time of the last follow up, ten of the twelve patients had graft incorporation without any resorbtion and two had minor bone graft resorption. Broken screws occurred in two of these ten cases. Two patients, both of whom required revision surgery, had failure of fixation and of graft incorporation; one of these failures was due to early postoperative trauma and the other, to Propionibacterium acnes infection. CONCLUSIONS The early and midterm results of total shoulder arthroplasty with autogenous bone graft demonstrated substantial clinical and radiographic improvement in most cases.
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Affiliation(s)
- Vani Sabesan
- Department of OrthopaedicSurgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Abstract
BACKGROUND Bone marrow edema syndrome (BMES) of the foot and ankle is an uncommon and often undiagnosed disorder that, to our knowledge, has not previously been reported in the orthopaedic literature. The current study reviews a consecutive series of patients who were seen with this musculoskeletal disorder in order to highlight the clinical presentation and diagnostic imaging characteristics specific to this disorder. MATERIALS AND METHODS A retrospective chart study was performed involving 601 patients who underwent magnetic resonance (MR) imaging of the foot and ankle at our institution from April 2005 to April 2006. We identified 14 patients whose MR imaging demonstrated findings consistent with BMES. RESULTS All 14 patients demonstrated characteristic diffuse, irregularly increased signal intensity on T2-weighted MR imaging and variable areas of decreased signal intensity on T1-weighted MR images in an average of three bones within the foot and ankle. Average patient age was 16.4 (range, 10 to 27) years, and no patient reported a history of prior trauma. Eight patients received treatment for an incorrect initial diagnosis with two of those patients undergoing surgical procedures. Twelve patients were successfully treated with supportive nonoperative therapy for an average length of 19.4 months. Four patients had followup MR imaging demonstrating signal changes consistent with their clinical improvement/changes. CONCLUSION BMES of the foot and ankle is a clinical disorder seen in younger patients with a clinical history of prolonged foot and ankle pain of unknown etiology and without prior trauma. MR findings from this series are consistent with previous descriptions in the radiology literature. Furthermore, MR imaging can be utilized to monitor the progression or resolution of this disorder. Proper diagnosis and treatment may prevent further unnecessary diagnostic testing or surgical procedures.
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Affiliation(s)
- Justin D Orr
- William Beaumont Army Medical Center, Section of Orthopaedic Surgery, 5005 N. Piedras St., El Paso, TX 79901, USA.
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Dolan LA, Sabesan V, Weinstein SL, Spratt KF. Preference assessment of recruitment into a randomized trial for adolescent idiopathic scoliosis. J Bone Joint Surg Am 2008; 90:2594-605. [PMID: 19047704 PMCID: PMC2657300 DOI: 10.2106/jbjs.g.01460] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Randomized controlled trials are powerful tools to evaluate the outcomes of clinical treatments. However, these trials tend to be expensive and time-consuming, and their conclusions can be threatened by several limitations. This study estimated the strength of three common limitations (underenrollment, selective enrollment, and nonadherence to protocol) in a proposed study of adolescent idiopathic scoliosis. METHODS Patients with scoliosis and their parents were asked to complete a web-based survey about their preferences concerning a hypothetical randomized trial. Adolescents without scoliosis and their parents also participated. Surveys included questions about treatment preference, likelihood of participation, required risk reduction, and propensity to drop out or choose a different treatment while enrolled in the study. RESULTS Ninety adolescents and eighty-three parents participated. Observation was preferred to bracing by the majority of subjects. Overall, 33% of the parents and adolescents would both agree to participate in the hypothetical trial. Of the subjects who would not agree to participate, the majority would rather share the decision-making responsibility with the physician than have the treatment chosen in a random fashion. Many of the subjects would consider changing treatments during the course of the trial if they were not satisfied with the outcomes; the majority of parents who preferred bracing would consider crossing over to the bracing arm if their children were randomized to observation. CONCLUSIONS Recruitment into a randomized trial of bracing compared with observation for the treatment of adolescent idiopathic scoliosis may well be problematic, considering the relatively small percentage of families who said they would consider randomization. Additionally, the threat of nonadherence to protocol may be strong and must be addressed in the protocol of the trial. Most families wanted to make the treatment decision with the physician in lieu of randomization; therefore, the role of the physician in patient recruitment and retention should not be underestimated.
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Affiliation(s)
- Lori A. Dolan
- Department of Orthopaedics and Rehabilitation, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for L.A. Dolan:
| | - Vani Sabesan
- Division of Orthopaedic Surgery, Duke University Medical Center, 200 Trent Drive, Box 3956, Durham, NC 27710
| | - Stuart L. Weinstein
- Department of Orthopaedics and Rehabilitation, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for L.A. Dolan:
| | - Kevin F. Spratt
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756
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Garrigues GE, Sabesan V, Aldridge JM. Acute distal radioulnar joint instability. J Surg Orthop Adv 2008; 17:262-266. [PMID: 19138499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The distal radioulnar joint (DRUJ) is critical for pronosupination of the forearm and for upper extremity function in general. Because of its critical role in tool handling, some authors place the human DRUJ on par with the opposable thumb in the evolution of man. This seemingly simple cylindrical joint is stabilized by a complex network of soft tissue constraints, primarily components of the triangular fibrocartilage complex. Chief among these are the dorsal and palmar radioulnar ligaments. Any injury that disrupts these stabilizers, their balanced tension, or the bony congruity of the joint will have a major deleterious effect on hand function. Although they can occur in isolation, injuries causing acute DRUJ instability generally are associated with other trauma to the forearm-wrist complex. When managing these associated injuries, it is paramount to have a high index of suspicion for associated acute DRUJ instability. If the DRUJ is evaluated and stabilized in the acute setting, the more difficult clinical problem of chronic DRUJ instability can be avoided.
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Affiliation(s)
- Grant E Garrigues
- the Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
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Zura RD, Sasser B, Sabesan V, Pietrobon R, Tucker MC, Olson SA. A survey of orthopaedic traumatologists concerning the use of bone growth stimulators. J Surg Orthop Adv 2007; 16:1-4. [PMID: 17371639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The purpose of the study was to determine the attitudes of members of the Orthopaedic Trauma Association (OTA) concerning the use and efficacy of bone growth stimulators. A questionnaire regarding bone growth stimulators was sent to the active members of the OTA. Descriptive statistics was performed using frequencies and percentages. All analyses were performed using Stata for Linux, version 8.0 (Intercooled Stata, Stata Corporation; College Station, TX). A response rate of 43% was obtained. Respondents indicated that they only occasionally used bone stimulators for the treatment of acute fractures and stress fractures. A majority of respondents have utilized stimulators for the treatment of delayed unions and nonunions. It was concluded that many members of the OTA utilize bone stimulators for delayed unions and nonunions, but not routinely for the treatment of acute fractures or stress fractures.
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Affiliation(s)
- Robert D Zura
- Duke University Medical Center, Durham, NC 27710, USA.
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Sabesan V, Cairo MS, Lones MA, Perkins SL, Morris E, Sposto R, Van De Ven C, Shiramizu B. Assessment of minimal residual disease in childhood non-hodgkin lymphoma by polymerase chain reaction using patient-specific primers. J Pediatr Hematol Oncol 2003; 25:109-13. [PMID: 12571460 DOI: 10.1097/00043426-200302000-00005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A feasibility study was undertaken to identify patient-specific primers (PSPs) from childhood non-Hodgkin lymphoma (NHL) specimens to detect minimal residual disease (MRD). Eleven tumor specimens were amplified using immunoglobulin heavy chain and T-cell receptor primers to identify PSPs, which were then used to evaluate staging/follow-up specimens. Disease was detected in 19 of 21 staging and 16 of 17 follow-up specimens. Among seven patients in remission by 1 month, PSPs identified MRD in follow-up specimens. This study demonstrated the feasibility of PSPs to identify disease in staging and follow-up specimens, which could be used to develop strategies for MRD analysis in a larger setting.
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MESH Headings
- Adolescent
- Burkitt Lymphoma/diagnosis
- Burkitt Lymphoma/genetics
- Child
- Child, Preschool
- DNA Primers
- DNA, Neoplasm/analysis
- Feasibility Studies
- Female
- Genes, T-Cell Receptor delta
- Genes, T-Cell Receptor gamma
- Humans
- Immunoglobulin Heavy Chains/genetics
- Infant
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, T-Cell/diagnosis
- Lymphoma, T-Cell/genetics
- Male
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/genetics
- Polymerase Chain Reaction/methods
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Affiliation(s)
- Vani Sabesan
- Indiana University School of Medicine, Indianapolis, USA
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